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When you’re seven years old and your mother tells you to drop what appear to be Paas tablets into a tube of your own pee, you giggle. Even though you know you’re supposed to take this whole “ketone testing” thing seriously, it’s still like Bill Nye the Science Guy. Only the experiments are taking place in your own bathroom. And it’s all in the name of managing your type 1 diabetes.

“Mom, the tube gets hot when I drop the tablet in. I don’t want to hold it!” I handed her the increasingly warmer test tube of urine like it was a hot potato. (Or a hot urine test tube, if you want to get all literal about it.)

“Okay, I’ll check it.” She took the tube into her hand while watching the second hand on the clock, waiting to compare the color to the chart on the Clinitest bottle, and estimate how much glucose I was spilling into my urine. This was ketone testing before we had the convenience of those handy little sticks that change color if ketones are present in our urine.

(I realize I sound like an old prospector from the 1800’s, talking about diabetes “in the old days.” Bear with me.)

Ketones. It’s a word that my musically-leaning spellcheck constantly wants to change to “key tones.” It’s the same word that sent Clara Barton Campers out with a full gallon of water to drink while other campers went swimming. And it’s a word I was wary of while pregnant with my daughter. The threat of ketones is present in every high blood sugar, and with every illness.

The Joslin website describes ketones as the product of too much glucose and not enough insulin. “Since the body is unable to use glucose for energy, it breaks down fat instead. When this occurs, ketones form in the blood and spill into the urine. These ketones can make you very sick.”

I describe ketones as “What Joslin said. And also a wicked headache. That constant need to pee and the incessant thirst. The feeling of sweaters on your teeth. Extreme lethargy and a glassy look to your eyes. And that dull ache in your lower back that all but convinces you that your kidneys are under some kind of attack.”

Testing for ketones is something I used to roll my eyes at until I really understood how they could impact my health. My doctors repeatedly instructed me to stay on top of any ketones that may crop up, and to call immediately if the ketones weren’t flushed out of my system within a few hours. A blood sugar over 240 mg/dl prompted a ketone test, and I would hold my breath, hoping the strip wasn’t turning purple as I counted down from fifteen seconds. Untreated ketones, combined with high blood sugar levels, can lead to diabetic ketoacidosis. Which can lead to death.

Which is not okay.

Now that diabetes is my own to manage, and I’m not under the careful watch of my fastidious mother, I am quick to test for ketones. I have a bottle of ketone test strips at the ready in my bathroom cabinet, just in case.

(But sometimes I still pretend I’m Bill Nye the Science Guy.)

About Kerri Morrone Sparling:Kerri has been living with type 1 diabetes since 1986 and has been writing the diabetes blog Six Until Me since early 2005. A passionate diabetes advocate, Kerri speaks regularly at digital media conferences about the impact of blogging on patient health. She currently lives in New England with her husband, their daughter, and a small army of cats.

You can read Kerri’s first guest post on the Joslin Diabetes Blog about managing her diabetes while pregnant here.

3 Responses to Guest Post: Experiences with Ketone Testing

I was diagnosed with type 1 in 1945, when I was 6, and my urine was tested with Benedicts solution and heated on the stove. My tests were reddish most of the time, and I may have had ketones, but we never heard that word back then. I continued urine testing for 40 years and had very high blood sugar most of the time. There was still no mentioning of ketones. In the late 1980s I finally found I was supposed to follow a low carb diet, and I bought a glucometer. In the late1990s I was given basal/bolus insulins. I stopped having so much high blood sugar. Now I am pumping and I rarely see a bad high or low. I have no diabetes complications after 65 years of type 1. As a participant in the Joslin Medalist Study, I hope the reason for no complications after so many years will be found. The Study is ongoing and some very interesting things have been discovered.

Kerri, take very good care of yourself and you may be a healthy old geezer like me someday. Lol!

P.S…… I have written a book about my first 64 years as a diabetic. I hope you will visit my fan page and look at the book.

One of my favorite axioms is: You can lead a diabetic child to ketone strips, but you can’t make her pee.

Shortly after beginning the insulin pump we discovered the blood ketone strips and they are so helpful for managing a child.

At school, it is much easier for the nurse or assistant principal to check her for ketones using the blood test. When we were still using the urine strips, I would often have to leave work to come help her try to pee into a cup or onto the strip!

I also find that we check for ketones more often now. No more waiting to see if she can pee. And with the blood test strips, we can even do it while she sleeps without disturbing her.

I hope by now you’ve learned that the Clinitest tablets were for glucose only — the Acetest tablets that you placed on a white paper towel and dropped one drop of urine on then checked the color after a certain number of seconds to see if it was purple were for ketones. I did a lot of those on hospitalized patients back in the 1960-70s.